Childhood physical abnormalities following paternal exposure to sulfur mustard gas in Iran: a case-control study

Using a case-control design, we identified all progenies of Sardasht men (exposed group, n = 498), who were born at least nine months after the exposure, compared to age-matched controls in Rabat, a nearby city (non-exposed group, n = 689). We conducted a thorough medical history, physical examination, and appropriate paraclinical studies to detect any physical abnormality and/or disorder. Given the presence of correlated data, we applied Generalized Estimating Equation (GEE) multivariable models to determine associations.The overall frequency of detected physical abnormalities and disorders was significantly higher in the exposed group (19% vs. 11%, Odds Ratio [OR] 1.93, 95% Confidence Interval [CI], 1.37-2.72, P = 0.0002). This was consistent across sexes. Congenital anomalies (OR 3.54, 95% CI, 1.58-7.93, P = 0.002) and asthma (OR, 3.12, 95% CI, 1.43-6.80, P = 0.004) were most commonly associated with exposure. No single abnormality was associated with paternal exposure to mustard gas.Our study demonstrates a generational effect of exposure to mustard gas. The lasting effects of mustard gas exposure in parents effects fertility and may impact child health and development in the long-term.Sulfur mustard gas [bis(2-chloroethyl)sulfide], first synthesized in early 1800 s, has been used in several major wars, and is a common chemical warfare agent [1]. Iraqi forces used it against civilian populations during the 1980-1988 Iran-Iraq war [2,3].Although mustard gas can have severe systemic effects on humans [1], it is best known as a skin vesicant. In a series of approximately 34,000 Iranian patients exposed to mustard gas, the lungs, eye, and skin were the most common sites of injury, in order of the greatest prevalence [4,5].Beside its acute effects, mustard gas has a number of known long-term effects on various body organs such as lung, stomach, bone marrow, and gonads [6-11]. In addition, sulfur mustard has been shown to influence the reproductive function in both an